Interactive Case Study - January 2022

‎60-year-old woman with a tender, rapidly growing nodule

Jaffar Khan MBBS

Ahmed Khalid Alomari‎ MD

A 60-year-old woman presented with a tender, rapidly growing nodule in her chest. A deep punch biopsy was performed.

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Figure 1. Clinical image

Figure 2. H&E, low power

Figure 3. H&E, high power

Figure 4. CK20, high power

Figure 5. CK7, high power

Figure 6.TTF-1, high power

What is the best diagnosis?

Basal cell carcinoma

Cutaneous T-cell lymphoblastic lymphoma

Ewing sarcoma

Merkel cell carcinoma

Metastatic small cell lung carcinoma

What additional ancillary findings are likely to be seen in this neoplasm?

Activating mutation in BRAF and NRAS

EWSR translocation

Immunohistochemical reactivity with chromogranin, synaptophysin and insulinoma-associated protein 1

Immunohistochemical reactivity for TdT and CD3

Positive PCR testing for Merkel cell polyomavirus

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Clanchy F. (2021). Rationale for Early Detection of EWSR1 Translocation-Associated Sarcoma Biomarkers in Liquid Biopsy. Cancers, 13(4), 824. https://doi.org/10.3390/cancers13040824
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Acknowledgements

Author Profiles

Jaffar Khan

Indiana University School of Medicine

Jaffar Khan, MBBS, is a second year resident in anatomic and clinical pathology resident Indiana University School of Medicine. He attended Bolan Medical School in Pakistan.

Ahmed Khalid Alomari‎

Indiana University School of Medicine

Dr. Ahmed Alomari is an assistant professor of clinical pathology, laboratory medicine and dermatology at the Indiana University School of Medicine. He is board certified in dermatopathology, anatomic pathology and clinical pathology. Dr. Alomari attended medical school at the Jordan University of Science and Technology. He finished his residency from the Yale University School of Medicine and fellowship from the University of Michigan Medical Center.

Question:

Interactive Case Study - January 2022

Acknowledgements

Author Profiles

‎60-year-old woman with a tender, rapidly growing nodule

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